Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Str.Chaoyang, Beijing, 100015, China.
Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Surg Endosc. 2021 Jun;35(6):2620-2628. doi: 10.1007/s00464-020-07682-6. Epub 2020 Jun 5.
This study aimed to compare the long-term outcome of endotherapy versus a combination of splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis (HBRC).
A total of 1074 patients with HBRC and acute variceal bleeding (AVB) treated with endotherapy and 248 patients with HBRC treated with a combination of splenectomy and devascularization surgery were included in the analysis. After one-to-one propensity score matching, 151 paired patients were selected. The primary end-point was death. The secondary outcomes were 3-year survival, 5-year survival, and rebleeding. Complications were recorded.
The median follow-up time was 1165 days in the endoscopic group and 1709 days in the surgical group. Before matching, the 1-year, 3-year, and 5-year survival rates were significantly lower in the endoscopic group than in the surgical group (91.1 vs 96.3%, P = 0.017; 79.6 vs 91.6%, P = 0.001; 65.2 vs 81.3%, P = 0.001). After matching, no significant differences were found between groups (94.5 vs 95.2%, P = 0.767; 87.0 vs 88.9%, P = 0.635; 77.9 vs 77.9%, P = 0.905). The rebleeding rate was lower in the surgical group than in the endoscopic group; the rebleeding-free survival rate was similar in the two groups. No patient died of complications. No statistically significant difference was observed in complications between groups.
Both endotherapy and a combination of splenectomy and devascularization are good choices for patients with AVB. The rebleeding rate was lower after the surgical procedure, but the long-term prognosis was similar.
本研究旨在比较内镜治疗与脾切除术加断流术联合治疗乙型肝炎相关肝硬化（HBRC）合并食管胃静脉曲张出血患者的长期疗效。
共纳入 1074 例接受内镜治疗的 HBRC 合并急性静脉曲张出血（AVB）患者和 248 例接受脾切除术加断流术联合治疗的 HBRC 患者。经 1:1 倾向评分匹配后，共选择 151 对患者。主要终点为死亡。次要结局为 3 年生存率、5 年生存率和再出血。记录并发症。
内镜组中位随访时间为 1165 天，手术组为 1709 天。匹配前，内镜组 1 年、3 年和 5 年生存率显著低于手术组（91.1%比 96.3%，P=0.017；79.6%比 91.6%，P=0.001；65.2%比 81.3%，P=0.001）。匹配后，两组间无显著差异（94.5%比 95.2%，P=0.767；87.0%比 88.9%，P=0.635；77.9%比 77.9%，P=0.905）。手术组再出血率低于内镜组，两组无出血生存率相似。无患者因并发症死亡。两组间并发症发生率无统计学差异。
内镜治疗和脾切除术加断流术联合治疗均是 AVB 患者的良好选择。手术治疗后再出血率较低，但长期预后相似。
